胸、腹腔镜联合微创治疗食管癌的应用体会  

Application experience of mini-invasive treatment of esophageal carcinoma combined with thoracoscopy and laparoscopy

作　　者：叶中瑞[1] 朱成楚[1] 叶加洪[1] 张锐利[1] 陈保富[1] 叶敏华[1] 马德华[1] 吴春雷[1] 王春国[1] 

机构地区：[1]台州医院,浙江临海317000

出　　处：《腹腔镜外科杂志》2011年第2期110-112,共3页Journal of Laparoscopic Surgery

摘　　要：目的：总结胸、腹腔镜联合微创治疗食管癌的临床经验。方法：回顾分析2007年8月至2010年4月为91例患者行胸、腹腔镜微创食管癌切除术的临床资料，其中食管上段癌16例，中段47例，下段28例。结果：本组手术均获成功。手术时间180～330min，平均260．4min，胸腔镜时间50～125min，腹腔镜时间38～90min；术中出血190～450ml，平均222．5ml，其中腹腔出血10～120ml，平均40．5ml；清扫淋巴结5～42枚，平均15．8枚，其中纵隔淋巴结11．2枚，腹腔淋巴结4．6枚；术后第1天开始行肠内营养或肠内营养加肠外营养，术后第7天进流食，术后第9天进软食，术后l例发生呼吸衰竭，5例喉返神经损伤，1例管状胃瘘合并左侧支气管瘘，4例吻合口漏，2例乳糜胸。随访2～35个月，6例吻合口狭窄，6例复发转移，7例死亡。结论：胸、腹腔镜联合微创治疗食管癌在技术上安全可行，值得推广应用。Objective ： To summarize the clinical experience of thoracoscopic and laparoseopic mini-invasive treatment of esophageal carcinoma. Methods ：The clinical data of 91 patients who underwent thoracoseopic and laparoscopie mini-invasive resection of esophageal carcinoma were retrospectively analyzed. The neoplasms located in superior segment of esophagus of 16 patients, in middle segment of 47 patients and inferior segment of 28 cases. Results ： All procedures were successfully performed. The operative time was 180-330min （mean 260.4min） ,the thoracoscopic time was 50-125rain and laparoscopic time was 38-90rain. The intraoperative blood loss was 190-450ml （mean 222.5ml）, and the hemorrhage in abdominal cavity was 10-120ml （mean 40.5ml）. The harvested lymph nodes were 5-42 （ mean 15.8） ,including 11.2 lymph nodes in mediastinum and 4.6 in abdomen. The enteral nutrition or enteral and parenteral nutrition was provided on the first day after operation, fluid food was taken on the 7th day postoperatively, and patients re- sumed soft diet on the 9th day. The postoperative complications included 1 ease of respirator3：failure,5 cases of recurrent laryngeal nerve injury, 1 case of gastric tube fistula combined with left bronchial fistula ,4 cases of anastomotic leakage, and 2 cases of chylotho- rax. During the follow-up of 2-35 months,6 cases of anastomotlc stricture,6 cases of r＇elapse and metastasis, and 7 cases of death occurred. Conclusions：The thoraeoscopic and laparoscopic mini-invasive treatment of esophageal carcinoma is safe and feasible, and wor- thy of generalization.

关 键 词：食管肿瘤 食管切除术 腹腔镜检查 胸腔镜检查 

分 类 号：R735.1[医药卫生—肿瘤]